Many Older Adults Develop Cardiovascular Conditions That Affect Anti-Amyloid Treatment

A new study finds that a significant portion of older adults with mild cognitive impairment or dementia develop new cardiovascular diagnoses each year that may require treatment with anticoagulants or thrombolytics — medications that doctors often avoid during anti-amyloid monoclonal antibody therapy for Alzheimer’s disease due to increased bleeding risk.

Anti-amyloid monoclonal antibodies such as lecanemab and donanemab are among the newest therapies to modestly slow cognitive decline in people with Alzheimer’s disease, but they carry a risk of amyloid-related imaging abnormalities, or ARIA, a brain imaging signal that can sometimes represent bleeding in the brain. Clinical guidance generally recommends against prescribing anticoagulants or thrombolytic drugs concurrently with anti-amyloid monoclonal antibodies because of the risk of intracranial hemorrhage.

The findings offer important context for clinicians, patients, and caregivers as they weigh the potential benefits and risks of anti-amyloid treatments.

The study, “Risk of New Indications for Anticoagulants and Thrombolytics in People With Cognitive Impairment: Implications for Anti-Amyloid Therapy,” published in Neurology, analyzed data from 12,373 adults aged 65 and older who participated in the nationally representative Health and Retirement Study from 2010–2020. None had a prior indication for anticoagulant or thrombolytic therapy at baseline.

Participants were categorized into three groups based on cognitive status — normal, mild cognitive impairment, or dementia — using validated assessments and linked Medicare claims. The study estimated the one-year incidence of new cardiovascular diagnoses, including atrial fibrillation, deep vein thrombosis, pulmonary embolism, acute myocardial infarction, and stroke.

The research team quantified exactly how often these medical “collisions” occur:

• Among people with mild cognitive impairment, the study estimated that within one year, about 5.7% developed a new condition that could indicate a need for anticoagulant or thrombolytic therapy. 
• For those with dementia, the corresponding one-year risk was approximately 6.7%.

The findings highlight that over the course of a year, a notable share of older adults with cognitive impairment or dementia may develop cardiovascular conditions for which anticoagulant or thrombolytic therapy is standard. Because current anti-amyloid treatment recommendations discourage anticoagulants or thrombolytics during therapy to avoid intracranial bleeding, these risks may factor into shared decision-making before starting such treatments.

“Our results provide national, real-world estimates of how often people with mild cognitive impairment or dementia develop conditions requiring anticoagulant or thrombolytic therapy,” said Dae Hyun Kim, MD, MPH, ScD, associate director and senior scientist at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research. “This information can help clinicians and families better understand the potential trade-offs when considering anti-amyloid monoclonal antibody therapy, especially given the bleeding risk associated with these treatments.”

In addition to Kim, researchers were Anna L. Parks, MD, assistant professor, University of Utah, Division of Hematology; Jacquelyn M. Lykken, PhD, senior system analyst, Division of General Internal Medicine, Massachusetts General Hospital; Meghan L. Rieu-Werden, MD, senior systems analyst, Division of General Internal Medicine, Massachusetts General Hospital; Darae Ko, MD, MSc, associate scientist, Marcus Institute, Hebrew SeniorLife; Margaret C. Fang, MD, professor, Division of Hospital Medicine, University of California San Francisco Health and director of research and the director of the UCSF Academic Hospital Medicine Fellowship; Steven M. Greenberg, MD, PhD, John J. Conway Endowed Chair in Neurology, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Daniel M. Witt, PHARMD, FCCP, BCPS, assistant dean of clinical affairs, University of Utah College of Pharmacy; Mark A. Supiano, MD, co-chief, Division of Geriatrics, Executive Director of Center of Aging, University of Utah, Salt Lake City; Sachin J. Shah, MD, MPH, investigator and assistant professor, DOM DGIM Research Physicians MGPO, Mass General Research Institute.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the /possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across seven campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; Jack Satter House, Revere; and Leyland Community, Dorchester. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $87 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 500 geriatric care providers each year. For more information about Hebrew SeniorLife, follow us on our blog, Facebook, Instagram, and LinkedIn.

About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.